Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap

Steven Lillis

doi:10.1071/HC23126

RESEARCH ARTICLE (Open Access)

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Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap

Steven Lillis

¹ ^*

+ Author Affiliations

- Author Affiliations

¹ Student Health, University of Waikato, Knighton Road, Hamilton, New Zealand.

^* Correspondence to: steven.lillis@outlook.co.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 16(1) 27-32 https://doi.org/10.1071/HC23126

Submitted: 4 October 2023 Accepted: 22 November 2023 Published: 11 December 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting about 7% of those aged up to 12 years, 5% of teenagers and 3% of adults. It is associated with poor academic performance, substance abuse, criminality, poor social functioning and other negative outcomes. Psychotherapeutic treatment is moderately successful, whereas pharmacotherapy with stimulant medication is more efficacious and is recommended in many international guidelines. Anecdotal evidence suggests underuse of these medications in Aotearoa, New Zealand.

Aim

To estimate how many patients with ADHD are prescribed psychostimulants in Aotearoa, New Zealand.

Methods

National prescribing data for dexamphetamine and methylphenidate in 2022 were obtained and matched against estimated prevalence of ADHD by age.

Results

There is a significant treatment gap for which inability to access first-line medication is likely to be the predominant explanation.

Discussion

The data suggest failure of our health system to provide reasonable health care for a significant number of people with ADHD, and results in inequity in outcomes. New approaches are needed that will increase access to first-line medication, yet maintain appropriateness of diagnosis and limit risk of medication diversion.

Keywords: access to medication, attention deficit hyperactivity disorder, dexamphetamine, health care inequity, methylphenidate, psychostimulants, primary health care, treatment gap.

References

1 Núñez-Jaramillo L, Herrera-Solís A, Herrera-Morales WV. ADHD: Reviewing the causes and evaluating solutions. J Pers Med 2021; 11(3): 166.
| Crossref | Google Scholar |

2 Sonuga-Barke E, Becker SP, Bölte S, et al. Annual Research Review: perspectives on progress in ADHD science–from characterization to cause. J Child Psychol Psychiatry 2023; 64(4): 506-32.
| Crossref | Google Scholar | PubMed |

3 Sibley MH, Rohde LA, Swanson JM, et al. Late-onset ADHD reconsidered with comprehensive repeated assessments between ages 10 and 25. Am J Psychiatry 2018; 175(2): 140-9.
| Crossref | Google Scholar | PubMed |

4 Breda V, Rohde LA, Menezes A, et al. The neurodevelopmental nature of attention-deficit hyperactivity disorder in adults. Br J Psychiatry 2021; 218(1): 43-50.
| Crossref | Google Scholar | PubMed |

5 Riglin L, Wootton RE, Livingston LA, et al. “Late-onset” ADHD symptoms in young adulthood: is this ADHD? J Atten Disord 2022; 26(10): 1271-82.
| Crossref | Google Scholar | PubMed |

6 Sibley MH, Arnold LE, Swanson JM, et al. Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry 2022; 179(2): 142-51.
| Crossref | Google Scholar | PubMed |

7 Demontis D, Walters RK, Martin J, et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 2019; 51(1): 63-75.
| Crossref | Google Scholar | PubMed |

8 Kim JH, Kim JY, Lee J, et al. Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review. Lancet Psychiatry 2020; 7(11): 955-70.
| Crossref | Google Scholar | PubMed |

9 Ministry of Health. 2002. New Zealand Health Survey. Available at [Accessed 16 November 2023]. https://minhealthnz.shinyapps.io/nz-health-survey-2021-22-annual-data-explorer/_w_df320287/#!/home[Accessed 16 November 2023].

10 Song P, Zha M, Yang Q, et al. The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis. J Glob Health 2021; 11: 04009.
| Crossref | Google Scholar |

11 Dobrosavljevic M, Solares C, Cortese S, et al. Prevalence of attention-deficit/hyperactivity disorder in older adults: a systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 118: 282-9.
| Crossref | Google Scholar | PubMed |

12 Hartman CA, Larsson H, Vos M, et al. Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: a substantive and methodological overview. Neurosci Biobehav Rev 2023; 151: 105209.
| Crossref | Google Scholar | PubMed |

13 Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, et al. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev 2022; 132: 1157-80.
| Crossref | Google Scholar | PubMed |

14 Shaw M, Hodgkins P, Caci H, et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med 2012; 10: 99.
| Crossref | Google Scholar |

15 Boland H, DiSalvo M, Fried R, et al. A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. J Psychiatr Res 2020; 123: 21-30.
| Crossref | Google Scholar | PubMed |

16 Stuhec M, Munda B, Svab V, et al. Comparative efficacy and acceptability of atomoxetine, lisdexamfetamine, bupropion and methylphenidate in treatment of attention deficit hyperactivity disorder in children and adolescents: a meta-analysis with focus on bupropion. J Affect Disord 2015; 178: 149-59.
| Crossref | Google Scholar | PubMed |

17 Correll CU, Cortese S, Croatto G, et al. Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry 2021; 20(2): 244-75.
| Crossref | Google Scholar | PubMed |

18 Connor DF. Psychostimulants in Attention Deficit Hyperactivity Disorder: Theoretical and Practical Issues for the Community Practitioner. In: Attention deficit hyperactivity disorder: From genes to patients 2005. Totowa, NJ: Humana Press; pp. 487–527.

19 Shrestha M, Lautenschleger J, Soares N. Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Transl Pediatr 2020; 9(Suppl 1): S114.
| Crossref | Google Scholar | PubMed |

20 Nimmo-Smith V, Merwood A, Hank D, et al. Non-pharmacological interventions for adult ADHD: a systematic review. Psychol Med 2020; 50(4): 529-41.
| Crossref | Google Scholar | PubMed |

21 Catalá-López F, Hutton B, Núñez-Beltrán A, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: a systematic review with network meta-analyses of randomised trials. PLoS One 2017; 12(7): e0180355.
| Crossref | Google Scholar | PubMed |

22 Australian ADHD Development Guideline Group. Australian Evidence-Based Clinical Practice Guideline For Attention Deficit Hyperactivity Disorder (ADHD); 2022. Available at https://adhdguideline.aadpa.com.au/download/

23 Almagor D, Don D, Gignac M. ADDRA - Canadian ADHD Resource Alliance: Canadian ADHD Practice Guidelines, 4.1 edn. Toronto, ON; CADDRA; 2020.

24 National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. 2018. Available at https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#medication

25 Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019; 56(1): 14-34.
| Crossref | Google Scholar | PubMed |

26 Andrews L. Primary Care Plays a Key Role in the Management of ADHD. 2007. Available at: https://bpac.org.nz/magazine/2007/february/pdfs/bpj3_adhd_pages8

27 Elliott J, Johnston A, Husereau D, et al. Pharmacologic treatment of attention deficit hyperactivity disorder in adults: a systematic review and network meta-analysis. PLoS One 2020; 15(10): e0240584.
| Crossref | Google Scholar | PubMed |

28 Pottegård A, Bjerregaard BK, Kortegaard LS, et al. Early discontinuation of attention‐deficit/hyperactivity disorder drug treatment: a Danish nationwide drug utilization study. Basic Clin Pharmacol Toxicol 2015; 116(4): 349-53.
| Crossref | Google Scholar | PubMed |

29 Fredriksen M, Peleikis DE. Long‐term pharmacotherapy of adults with attention deficit hyperactivity disorder: a literature review and clinical study. Basic Clin Pharmacol Toxicol 2016; 118(1): 23-31.
| Crossref | Google Scholar | PubMed |

30 Radio New Zealand. No capacity to test adults for ADHD a ‘major issue’, GPs NZ head says. 10 May 2023. Available at https://www.rnz.co.nz/news/national/489645/no-capacity-to-test-adults-for-adhd-a-major-issue-gps-nz-head-says [Accessed 28 September 2023].

31 Radio New Zealand. Health system rethink on ADHD desperately needed – advocate. 9 October 2022. Available at https://www.rnz.co.nz/news/national/476928/health-system-rethink-on-adhd-desperately-needed-advocate [Accessed 27 September 2023].

32 D’Souza S, Bowden N, Gibb S, et al. Medication dispensing for attention-deficit/hyperactivity disorder to New Zealand youth. N Z Med J 2020; 133(1522): 84-95.
| Google Scholar | PubMed |

33 Cargo T, Stevenson K, Bowden N, et al. Medication dispensing among Maori and non-Maori screened for preschool ADHD. N Z Med J 2022; 135(1565): 95-103.
| Google Scholar |

34 New Zealand Gazette. Restriction on the Supply of Methylphenidate—Approval to Prescribe, Supply and Administer (Approval No. 2015/AP001). Available at: https://gazette.govt.nz/notice/id/2015-go760.

35 New Zealand Gazette. Restriction on the Supply of Dexamphetamine—Approval to Prescribe, Supply and Administer (Approval No. 2015/AP002) - 2015-go761 - New Zealand Gazette. Available at: https://gazette.govt.nz/notice/id/2015-go761

36 Tatauranga Aotearoa. Population. 2022. Available at https://infoshare.stats.govt.nz/ViewTable.aspx?pxID=4af41156-9b3d-4e78-94b2-c4ea9bf655d9

37 Maneeton N, Maneeton B, Intaprasert S, et al. A systematic review of randomized controlled trials of bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat 2014; 10: 1439-49.
| Crossref | Google Scholar | PubMed |

38 Gray B, Hurtado C, Hudson J, et al. Is bupropion monotherapy efficacious for ADHD in adults? Evidence Based Pract 2020; 23(10): 39.
| Crossref | Google Scholar |

39 Groom MJ, Cortese S. Current pharmacological treatments for ADHD. In: Stanford S, Sciberras, E editors. New Discoveries in the Behavioral Neuroscience of Attention-Deficit Hyperactivity Disorder. 2022. pp. 19-50.

40 Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018; 5(9): 727-38.
| Crossref | Google Scholar | PubMed |

41 Sedgwick JA, Merwood A, Asherson P. The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD. Atten Defic Hyperact Disord 2019; 11: 241-53.
| Crossref | Google Scholar | PubMed |